Differential Diagnosis for Right Apical Pleural Thickening
Single Most Likely Diagnosis
- Tuberculosis (TB): This is often considered the most likely diagnosis for right apical pleural thickening, especially in regions with high TB prevalence. TB can cause pleural thickening due to chronic inflammation and fibrosis.
Other Likely Diagnoses
- Asbestos-related disease: Asbestos exposure can lead to pleural thickening, often bilateral but can be unilateral, and is a common cause in individuals with a history of asbestos exposure.
- Pneumonia or Empyema: Complicated pneumonia or empyema can result in pleural thickening, particularly if there has been a chronic or recurrent infection.
- Lung Cancer: Malignancies, especially those originating from the lung, can cause pleural thickening due to direct invasion or metastasis to the pleura.
Do Not Miss Diagnoses
- Malignant Mesothelioma: Although rare, this diagnosis is critical not to miss due to its poor prognosis and association with asbestos exposure. It can present with unilateral pleural thickening.
- Pulmonary Embolism with Infarction: While less common, pulmonary embolism can lead to infarction and subsequent pleural thickening, especially if there is associated hemorrhage.
Rare Diagnoses
- Sarcoidosis: This systemic granulomatous disease can affect the lungs and cause pleural thickening, though it is less common compared to other manifestations like hilar lymphadenopathy.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis): A form of vasculitis that can affect the lungs and cause pleural thickening among other pulmonary manifestations.
- Lymphangitic Carcinomatosis: Metastatic disease to the lymphatics of the lung can cause pleural thickening, though this is relatively rare and usually part of widespread disease.